Doctors focus on teen health issues

Adolescent medicine a small but growing specialty

Adolescent medicine a small but growing specialty

September 20, 2006|ALISON FREEHLING Newport News (Va.) Daily Press

NORFOLK, Va. -- The health concerns of Dr. Joel Brenner's specialty are, to his patients, often blush-worthy. Acne, irregular periods and sexually transmitted diseases are on the list. So are depression, substance abuse and eating disorders. Brenner's job is to get the teenagers he treats to trust him, talk truthfully and find the medical help they need. This is the world of an adolescent medicine specialist, a small but growing breed of doctor with in-depth training working with teenagers. Brenner is the head of a new regional adolescent medicine clinic that opened this summer at Children's Hospital of the King's Daughters in Norfolk. By treating patients ages 10 to 21, Brenner hopes to bridge the gaps between care for young children -- who tend to have simpler concerns such as ear infections and pink eye -- and full-fledged adults. "This is a group of patients that can kind of get lost in the health care system," he said. "We need to take care of them better and also help pediatricians and other doctors be more comfortable with them." To be clear, many types of doctors spend plenty of time with teenagers, including psychiatrists, gynecologists, diabetes specialists and physical therapists. Pediatricians and family practice doctors also see patients from infancy through old age. But adolescent medicine specialists say they tend to operate a little differently. They have more experience with sensitive problems such as hormonal imbalances, ovarian cysts and abnormal menstruation. They also ask very specific questions about sex, drugs and drinking. Instead of telling a patient not to smoke marijuana, for example, adolescent medicine specialists might ask how many of his classmates have used the drug and how he would deal with a friend who offered him a joint. And they'll direct most of their questions to the teenager, not his parents. "When you get them alone and talking with no outside pressures around, you can really find out what interests them and stresses them," Brenner said. "If you don't ask the direct questions, you're not going to get the answers -- but then you have to know what to do with those answers." Medical schools and residency programs have added training in adolescent medicine in recent years, but the country still needs many more specialists, said Edie Moore, executive director of the Society for Adolescent Medicine. The national group has certified about 1,000 doctors in the subspecialty since first offering an examination in 1994. About 100 new doctors -- mainly from pediatrics, internal medicine or family medicine -- join that list each year, Moore said. Specialists are moving beyond major medical centers and universities, but slowly. "Look at how many adolescents there are in the country," Moore said. "They need a health professional who is able to pull stuff out of them at times and listen at other times." Teenagers are at high risk for unhealthy behavior, many health surveys have found. Half of new sexually transmitted infections a year are in 15- to 24-year-olds, for example, and one in five people between the ages of 12 and 20 has downed five or more drinks in a sitting on at least one occasion. Uncovering those issues takes a combination of tact and bluntness, teen specialists say. Most doctors first meet with new patients and their parents together to lay out rules on confidentiality (in general, confidentiality is kept unless teens are at risk of hurting themselves or being hurt by someone else). Then they break the ice with questions about hobbies, school and career goals before hitting the touchier topics. "We use many methods to ask teens about problem behaviors," said Dr. Robert Brown, president of the Society of Adolescent Medicine and an Ohio-based doctor. "Interactive interviewing, questionnaires, computer or pencil checkoff lists, etc." While some adolescent medicine specialists will replace a teen's childhood pediatrician, Brenner sees only patients referred by their family doctor. "I'm not a primary care physician," he said. "I'm just there to assist them." On a recent day, 16-year-old Ellie Barnes sipped a Starbucks coffee in the waiting room. Barnes, a high school senior from Virginia Beach, Va., said she likes Brenner's pull-no-punches approach. "He's very straightforward," she said. "He just asks direct questions, and you don't have to talk about a bunch of other stuff that doesn't matter. And he is nice no matter what you tell him." Julie Barnes, Ellie's mother, also is grateful. "He's the first doctor who ever called me back personally with lab results, and that was within an hour," she said. "I actually thought it was a prank call at first. For a parent, it is such a relief to find a place with a specific focus like this." Brenner plans to expand the clinic's reach in the future. He hopes to bring in a second doctor and possibly open a few school-based clinics. In the meantime, he's teaching local medical students and residents about adolescent medicine and his second specialty, sports medicine. "This is a challenging age group, yes," he said, "but the work is just very rewarding."